自体荧光联合纳米碳在甲状腺术中识别甲状旁腺的临床应用

Clinical application of near-infrared fluorescence combined with nano carbon in the recognition of parathyroid gland during thyroidectomy

目的评估自体荧光联合纳米碳在甲状腺术中识别甲状旁腺的效果。方法选取2019-09-01-12-31在山东第一医科大学附属第一医院行手术治疗的100例甲状腺癌患者病例资料,根据入院时间将患者分为荧光联合纳米碳组(50例)和单用纳米碳组(50例)。联合组术中采用自体荧光联合纳米碳的方法识别甲状腺术中甲状旁腺,并通过快速病理确诊是否为甲状旁腺。比较2组患者甲状旁腺识别准确率、假阴性率、是否存在误切及永久性甲状旁腺功能减低患者。结果2组患者的性别(χ^(2)=0.06,P=0.80)、年龄(t=1.70,P=0.89)、身体质量指数(t=-1.34,P=0.26)、手术方式(χ^(2)=0.10,P=0.74)及手术范围(χ^(2)=0.04,P=0.85)差异均无统计学意义。联合组甲状旁腺识别的准确性高于纳米碳组(χ^(2)=6.08,P=0.01),且联合组术后常规病理未发现误切的甲状旁腺,纳米碳组发现2枚误切的甲状旁腺。联合组术后6个月甲状旁腺激素为(29.50±15.41)ng/L,纳米碳组为(27.44±8.42)ng/L,差异有统计学意义,t=0.82,P=0.03;术后6个月联合组患者甲状旁腺功能全部恢复正常,纳米碳组出现1例永久性甲状旁腺功能减低。结论自体荧光联合纳米碳的方法识别甲状旁腺安全有效,可以提升甲状旁腺识别率,减少误切,缩短甲状旁腺离体时间,提高甲状旁腺移植成活率,降低术后永久性甲状旁腺功能减退发生率。

Objective To evaluate the effect of autofluorescence combined with nano carbon in identifying parathyroid glands during thyroidectomy.Methods From September 1,2019 to December 31,2019,100 patients with thyroid cancer underwent surgery in the First Affiliated Hospital of Shandong First Medical University were enrolled in the analysis.According to the time of admission,the patients were divided into autofluorescence combined with nano carbon group(50 cases)and nano carbon group(50 cases).In the combined group,the method of autofluorescence combined with nano carbon was used to identify the parathyroid gland during thyroid surgery,and the parathyroid gland was confirmed by rapid case diagnosis.The accuracy rate of parathyroid recognition,false negative rate,the presence of false cutting and permanent hypoparathyroidism were compared between the two groups.Results There were no significant differences in gender(χ^(2)=0.06,P=0.80),age(t=1.70,P=0.89),BMI(t=-1.34,P=0.26),operation modes(χ^(2)=0.10,P=0.74)and operation range(χ^(2)=0.04,P=0.85)between the two groups.The accuracy of parathyroid identification in the combined group was higher than that in the nano carbon group(χ^(2)=6.08,P=0.01),and there was no mistakenly cut parathyroid in the combined group,and two mistakenly cut parathyroids were found in the nano carbon group.Parathyroid hormone(PTH)in the combined group was(29.50±15.41)ng/L,and that in the nano carbon group was(27.44±8.42)ng/L at 6 months after operation,the difference was statistically significant(t=0.82,P=0.03);Six months after operation,parathyroid glands in the combined group all returned to normal,while one patient in the nano carbon group had permanent hypoparathyroidism.Conclusions It is safe and effective to identify parathyroid gland by autofluorescence combined with nano carbon.It can significantly improve the recognition rate of parathyroid,reduce false cutting,shorten the time of parathyroid in vitro,improve the survival rate of parathyroid transplantation,and reduce the incidence of postoperative permanent hypoparathyroidism.